If you have a pre-existing medical condition, that means you have a disease or illness for which you had symptoms, required treatment, or which you were aware of, although you did not seek treatment for it before the start of your medical insurance policy.
Insurers may consider any medical condition you may have had in your life before buying an individual medical plan as a pre-existing condition.
Here we will look at the key things to consider if you have a pre-existing medical condition when considering buying medical insurance or switching providers or plan:
Table of contents
1. How do insurers become aware of my pre-existing condition?
The insurers will ask you to fill out a medical questionnaire if you do not apply for a moratorium contract. You must respond to the best of your ability and reveal any condition before the start of the insurance plan. If you do not and in full awareness conceal a condition or hold back information, this means you risk having your claim dismissed and the insurance contract invalid.
2. How do insurance providers handle pre-existing conditions?
There are 4 key avenues the insurer deal with pre-existing conditions:
Exclusion of the Condition
Your policy won’t cover exclusion. All disease-related treatment costs will not be repaid.
Moratorium or Waiting Period
Some pre-existing conditions arose a long time ago and are no longer showing symptoms. Occasionally, it is possible to ask the insurer to apply a moratorium which is a defined time period during which you will not get coverage for your medical costs. The length of such waiting periods are normally 2 years. Unless any symptoms happened during that time, your condition will be officially covered at the end of it.
Some insurers cover pre-existing conditions in return for a higher premium. Since the disease is no longer a risk however it is most likely to happen, the premium cannot be as low as for someone perfectly healthy.
An upside of being covered as an employee under group coverage is the fact that coverage is always there for pre-existing conditions.
If you quit your job you may ask for converting the group coverage into the individual cover so the pre-existing conditions can stay covered. Portability is also known as “guarantee of conversion”.
3. What are the risks of not disclosing your pre-existing conditions?
In full consciousness, if you conceal your pre-existing conditions from the insurer and your insurer discovers, here is what can take place:
- The insurer can end your policy at once. Then you lose your medical protection and you are probably asked to pay back all the medical claims for which you were repaid.
- The insurer can use an exclusion retroactively. You stay covered but you are ineligible for past or future claim reimbursements with the condition that is currently officially excluded.
- The insurer can use a loading retroactively. You get coverage but with a surcharge on your premium.